[Tracheomalacia (TM) or bronchomalacia (BM) in children: conservative or invasive therapy]

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Congenital Airway Abnormalities

Context:

• Tracheomalacia (TM) and bronchomalacia (BM) are characterized by tracheal or bronchial wall weakness.
• Current management strategies for TM/BM lack robust evidence-based guidelines.
• Conservative approaches are often successful in milder cases within the first two years of life.

Purpose:

• To review the current understanding and management approaches for tracheomalacia and bronchomalacia.
• To highlight the limited evidence supporting non-specific treatments.
• To outline treatment considerations for symptomatic and severe cases.

Summary:

• Management of TM/BM is not evidence-based, with conservative therapy preferred for milder cases.
• Non-specific treatments like anti-inflammatory agents, bronchodilators, antibiotics, and physiotherapy lack proven clinical utility.
• Symptomatic cases require individualized management, avoiding airway surgery where possible, with non-invasive ventilation as a temporary measure.
• Severe cases may necessitate aortopexy, tracheostomy, or stent placement, with regular respiratory monitoring crucial until remission.

Impact:

• Informs clinical decision-making for pediatric airway disorders.
• Emphasizes the need for individualized treatment plans in TM/BM.
• Highlights the importance of monitoring respiratory status in affected infants and children.